PROJECT SUMMARY Parent Grant: Pregnant women are at substantial risk of contracting HIV in high HIV prevalence settings. Pre- exposure prophylaxis (PrEP) has the potential to further reduce the risk of HIV acquisition and complement existing prevention efforts in antenatal care (ANC) programs. The ?Delivering PrEP in Pregnancy? (5R01AI125498-02), aims to compare and qualitatively assess the barriers and facilitators of two models of PrEP delivery in pregnant women in a cluster-randomized trial: universal PrEP (women self-select) or targeted PrEP (offer to women with high risk score). Proposed Diversity Supplement: One of the challenges to optimizing uptake of PrEP among pregnant women is that few women who present for ANC do so within the first trimester. This is a lost opportunity for early access to PrEP. Informal and formal retail pharmacies [?drug shops?] could potentially serve as accessible sites at the community level for distributing pregnancy tests and encouraging women, if they are pregnant, to get ANC, HIV testing and PrEP early. In this Diversity Supplement, we propose a mixed-methods study to determine whether it is feasible to engage drug shop providers in the distribution of pregnancy tests and promotion of early access to ANC and PrEP among pregnant women. In Aim 1, we will conduct a cross-sectional survey among women attending maternal and child health (MCH) clinics, which are the sites of the parent R01, to determine the strategies and sources of care that women use to confirm and manage early pregnancy. The objective of this aim is to determine the extent to which women access drug shops to purchase pregnancy tests and manage early pregnancy needs. In Aim 2, we will conduct qualitative interviews among women attending MCH clinics to identify the factors and motivations that influence how women select sources of care in early pregnancy. In Aim 3, we will conduct qualitative interviews among potential users (women of childbearing age), providers (drug shop providers, community health workers, nurses) and decision-makers (policy-makers, regulators, program managers) to identify the perceptions of ANC and PrEP referral strategies via drug shops. The proposed research is innovative, in our opinion, because it represents a new and substantive departure from the status quo by exploring how to accelerate early access to both ANC and PrEP via drug shop providers, which are not normally considered within the cadre of community health workers. We will use the data generated from this study to design and test an intervention to close gaps in early access to ANC, accelerate PrEP access and uptake among pregnant women at substantial risk for HIV and strengthen the preventive impact of PrEP. With 2-year Diversity Supplement proposed support, the candidate will gain skills in qualitative research and aim to submit a K application building on findings from the Supplement.